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Old 07-15-2014, 09:04 AM   #21
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+1. My doctor's office was trying to change a routine annual physical (which is no cost to me) into an office visit ($20 copay) all the time, if I asked any questions at all. Had to have a talk with them. Now I can get my RAP and ask questions, and it stays coded as RAP. But I always remind them I'm coming in for a routine annual physical, not an office visit.

In the good ole days, a routine annual physical was when you were expected to mention any medical concerns you had at the time. You weren't charged extra for that luxury.

Your second paragraph is the impression I was under for one of these. So what good is the purpose of one of these visits then? I can check my weight and BP on my own.


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Old 07-15-2014, 09:10 AM   #22
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Your second paragraph is the impression I was under for one of these. So what good is the purpose of one of these visits then? I can check my weight and BP on my own.


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Free bloodwork is one of the major things. I call it a 'well baby' check.
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Old 07-15-2014, 09:20 AM   #23
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Free bloodwork is one of the major things. I call it a 'well baby' check.

Thanks Buckeye. Well I guess a person gets something out of it. I noticed I can get a complete 12 panel bloodwork for $45 at a nearby lab, and just skip the doctor. Last year I went I got my visit free for my "wellness check", I know I had to pay about a $100 for my bloodwork at the hospital where my doctor works. Maybe older policies are different.


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Old 07-15-2014, 09:27 AM   #24
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My doctor will not write prescriptions for me unless I have a physical every year. I get any bloodwork done at a lab, and it only costs $12 per lab visit, on my current insurance. But you're right, Mulligan, many blood tests can be had for cash for pretty low prices, if you shop around.
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Old 07-15-2014, 09:28 AM   #25
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I'm 58 and pay $467 for an individual plan with $5000 deductible through Cigna (not through Obamacare). It has been a very good plan other than the higher deductible. Cigna offered it to me for an additional year through the end of 2014 although I'm not sure if they're going to offer it again in 2015. If not, I'll be switching to Obamacare. I was diagnosed with multiple myeloma (a blood cancer) about a year ago and with the high treatment costs (over $12,000/month for just one of the maintenance treatment drugs), I no longer look for the most affordable plan as far as premiums go but the plan that will cover most of my treatments even if it means a much higher premium. After all, even a 10-20% cost sharing for drug treatments would be very expensive for me.

I've looked at the current Obamacare plans and if I had to switch today, I'd probably end up with a gold plan with a monthly premium of about $360-390 (after the subsidy...my retirement income is about $30,000/year). I'm guessing that those premiums will rise in 2015. They don't offer any platinum plans where I live.
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Old 07-15-2014, 06:28 PM   #26
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$1177 a month COBRA for self and spouse for dental, vision, drugs, mental health. 100/70 PPO style plan. Deductibles are $10 to $50 depending on who you see and where.


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Old 07-15-2014, 06:37 PM   #27
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$394mth for DW and me. Std BCBS PPO plan. Still with megacorp subsidized plan. Not sure how much longer I will have access to this plan. Would not receive any subsidy under AHCA so hopefully can keep this till Medicare kicks in.


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Old 07-18-2014, 11:46 PM   #28
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Still working, so I luckily pay for a single plan only about $210 a month for a PPO with recent copay increases, increases in drug copays and various limitations, but a $3000 out of pocket maximum per year. My original plan was to retire 18 months prior to Medicare age in 4/2015 and go onto COBRA.

However my employer may be switching to a HD plan next year in 7/2015 and if one is on COBRA one can't contribute to the HSA, which I don't have now. So if I go with COBRA I will pay about $800+ a month, have a $6000 a year out of pocket maximum and have no tax deductible HSA to contribute to. Since you only have 30 days I think after the qualifying event (retirement in this case) if I retire in 4/2015 I have to pay the COBRA premium by 5/30/2015 and my employer's plan won't be announced until 6/2015. So I may be screwed.

OTOH I can get an unsubsidized ACA plan after I leave not quite megacorp (but biggest in its field), but being 63 I will probably pay as much as or more than the COBRA with fewer doctor choices here in Texas, which is not exactly the land of great and available healthcare. Then if I get an HD ACA plan I can contribute to an HSA.

What to do, what to do...

I'm just trying to make it to 65, Medicare and an F supplement like my 72 year old DH has.


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Old 07-19-2014, 03:20 AM   #29
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I pay about $230/month. Individual, Bronze plan, 6K deductible, then 100% covered after deductible met. It's a HSA.
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Old 07-20-2014, 05:21 PM   #30
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DW got this. Our cost would have been same for both of us but I have VA so only she is signed up under ACA.

Monthly premium $115.08/mo.
Deductible. $150
Out-of-pocket maximum. $2,250
Copayments / Coinsurance
$10 Copay before deductible/30% Coinsurance after deductible Primary doctor
$10 Copay before deductible/30% Coinsurance after deductible Specialist doctor
$10 Generic drugs



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Old 07-20-2014, 06:15 PM   #31
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About $140 a month here for a BCBSTX Bronze PPO plan (about $270/mo before subsidy, age 48). Since I am a member of a federally recognized Indian tribe, as long as we can keep our MAGI under 300% of FPL (about $46K for us) I have no copayments or deductibles at all. Otherwise, this plan would have a $6000 deductible and OOP max.

DW is covered by Gold-level group insurance through her employer and they pay 100% of the premium. I'm on my own.
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Old 07-20-2014, 06:38 PM   #32
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I recently switched to COBRA. We're paying $1283 for a family of 4, for dental and Kaiser Permanente medical, with a $20 copay per office visit and $100 for ER. Prescriptions are $20 or the actual cost if it's less. No deductible for the medical. The dental covers the annual cleanings 100%, 80% of fillings, 60% of crowns, with a $200/person, $300/family deductible. It also reduced our orthodontist bill. (Kids will be out of braces by the end of the year.)

My husband and older son have soft teeth - so I need to keep dental in place.... it pays for itself.

I didn't qualify for ACA subsidies this year since I was working for 1/2 the year, got paid out PTO and bonus, etc... Next year we will sign up for ACA and should qualify for subsidy. A similar Kaiser plan will cost us about $900/month (with subsidy). It will have $50/copays though. I'm also looking at Kaiser's high deductible HSA plans on the HSA. We want to stay with Kaiser since my husband likes his doctor and we really like our pediatrician. (I'm ambivalent about my doctor and my switch to my husband's doctor.)

I priced non-subsidized plans directly with Kaiser and through the ACA website - I am getting a good deal with COBRA.
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Old 07-20-2014, 06:52 PM   #33
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As a retiree, I pay half the group rate negotiated by my former employer for my UPMC (Univ. of Pittsburgh Medical Center) PPO plan which amounts to $248.00 a month. I consider this a bargain, have it auto-deducted from my pension. I have a co-pay of $15/visit for my PCP, $25.00/visit for a specialist (no referral needed to see a specialist), and $50.00 to visit the ER. Medications are up to $25.00 per script.
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Old 07-21-2014, 02:40 PM   #34
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My hubby & i pay $10,000/year thru our former employer. It is good insurance with low co-pays.
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Old 07-22-2014, 10:28 AM   #35
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I didn't qualify for ACA subsidies this year since I was working for 1/2 the year, got paid out PTO and bonus, etc... Next year we will sign up for ACA and should qualify for subsidy.
Do you know what documentation you plan to use for income verification? I'm in the same situation, worked enough this year to be well beyond subsidy limits but I won't have a tax return showing my income qualifies until after I file my 2015 taxes.
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Old 07-22-2014, 11:40 AM   #36
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My hubby & i pay $10,000/year thru our former employer. It is good insurance with low co-pays.

Terry, thanks for the response. Is your HI obtained through COBRA?
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Old 07-22-2014, 12:37 PM   #37
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Do you know what documentation you plan to use for income verification? I'm in the same situation, worked enough this year to be well beyond subsidy limits but I won't have a tax return showing my income qualifies until after I file my 2015 taxes.
When I enrolled last year, I was never asked for documentation of income. Had they used the most recent tax return available at the time (2012), it would have reflected an income almost 3x higher than it was at the time I enrolled (was laid off earlier in the year). So somehow when I entered our current income it didn't spit it out because my tax return history was much higher. As it is it looks like I somewhat underestimated our 2014 income but I am being a little overwithheld on taxes plus I'm still contributing to a TIRA to keep our MAGI down, so it's no big thing -- the excess subsidy I'm getting will be offset by the extra tax withholding. I'll fix it later this year, which would only reduce the subsidy somewhat.

The only documentation I had to provide was my tribal enrollment card which doubled as a CDIB (Certificate of Degree of Indian Blood).
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Old 07-22-2014, 01:18 PM   #38
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I am paying $104.90/month for Medicare Part B, plus an additional $190.28 for federal employee/retiree insurance, which picks up many expenses that Medicare doesn't.

So, my total insurance cost is $295.18/month.

I have no dental or optical insurance, and pay for those costs completely out of pocket.
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Old 07-22-2014, 04:59 PM   #39
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Ziggy - thanks for sharing your experience. I hope it goes smoothly if I apply for a subsidy upfront.
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Old 07-22-2014, 11:22 PM   #40
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No it is not Cobra. It is the rate that state retirees have to pay. When I was an active employee I paid about a third of what I do now which really makes no sense. Since I am 5 years older then my hubby when I get on Medicare I will have to still pay most of the amount for him to have insurance.
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